Provider Demographics
NPI:1548829500
Name:MARIN, CARLA (PHD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MARIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 TRUMBULL ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1004
Mailing Address - Country:US
Mailing Address - Phone:203-675-1093
Mailing Address - Fax:
Practice Address - Street 1:47 TRUMBULL ST STE 204
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1004
Practice Address - Country:US
Practice Address - Phone:203-737-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3842103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist